Infrequent Stools / Constipation

What Causes Constipation?

In order to deal properly with constipation we need to understand and — if possible — remove the underlying causes and risk factors.  We need to ask: "What else is going on inside the body that might allow constipation to develop?"

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Accurate diagnosis of the factors behind constipation consists of three steps:

Step 1: List the Possible Causative Factors

Identify all disease conditions, lifestyle choices and environmental risk factors that can lead to constipation.  Here are eight of many possibilities (more below):
  • Fibroids
  • Increased Intestinal Permeability
  • Mesenteric Ischemia
  • Bariatric Surgery Complications
  • Guillain-Barre Syndrome
  • Irritable Bowel Syndrome
  • Fluorosis
  • Low Carbohydrate Diet Consequences

Step 2: Build a Symptom Checklist

Identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
severe abdominal pain
migraine headaches
recent onset vomiting
heaviness of the legs
regular rashes
severe flatulence
allergies to certain foods
having a learning disability
recent onset nausea
low lymphocyte count
indoor allergies
severe vision disturbances
... and more than 80 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of constipation:
Cause Probability Status
Fibroids 91% Confirm
Irritable Bowel Syndrome 20% Unlikely
Increased Intestinal Permeability 12% Unlikely
Low Carbohydrate Diet Consequences 3% Ruled out
Mesenteric Ischemia 0% Ruled out
Fluorosis 0% Ruled out
Bariatric Surgery Complications 0% Ruled out
Guillain-Barre Syndrome 0% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate irregular stools, The Analyst™ will ask further questions including this one:
Do you suffer from constipation?
Possible responses:
→ Not applicable / don't know
→ No, I usually pass at least one stool per day
→ Yes, I often have a day with no bowel movement
→ Yes, I often go 2-3 days with no bowel movement
→ Yes, I often go 3+ days with no bowel movement
Based on your response to this question, which may indicate normal stool frequency, tendency to infrequent stools, constipation or severe constipation, The Analyst™ will consider possibilities such as:
Anxiety

This connection is discussed in the link between constipation and stress.

Effects of a Low Carbohydrate Diet

Authorities recommend that Americans get "at least 30-35 grams" [Gastroenterology 118 (2000): p.1233] of fiber each day "from foods, not from supplements." [Circulation.  102 (2000): p.2284] The initial phase of Atkins' diet, which dieters may have to repeatedly return to, has about 2gm of fiber per day.  [Atkins, RC.  Dr. Atkins New Diet Revolution.  Avon Books, 1999]

The May 2004 Annals of Internal Medicine study showed once again that most of the Atkins Dieters are constipated and headachy.

Fibroids

Mural fibroids (located in the uterine wall) and subserous fibroids (protrude outside the uterine wall) may reach a large size before causing symptoms.  These symptoms may include pressure on the bladder with difficulty voiding or urinary frequency and urgency, pressure on the rectum with constipation, lower back and abdominal pain, as well as heavy or irregular bleeding during periods.

Fluoride Toxicity

Chronic constipation is an early sign of fluorosis.

Guillain-Barre Syndrome

Constipation is often a problem, due to the reduced activity of the intestines, change of diet, weakened stomach muscles that resist efforts by the patient to express the intestinal content.

Hypothyroidism

Constant constipation is a sign of hypothyroidism.

Stress

In a study of 34 women with chronic constipation, investigators led by Dr. Anton Emmanuel and colleagues at St.  Mark's Hospital in Middlesex linked emotional distress with changes in the nerve pathway that helps control gut function.  They say the findings suggest a specific path through which psychological factors directly influence the digestive system.

The researchers compared the patients, who had suffered bouts of constipation for an average of 21 years, with a group of women with no history of gastrointestinal illness.  All took standard tests that measure psychological symptoms such as anxiety and depression, self-image, social functioning and ability to form intimate relationships.

Women with chronic constipation were more likely than healthy women to report anxiety, depression and feeling less "feminine".  They also found it harder to form close relationships.  [Gut Aug 2001;49: pp.209-213]

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